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Case No : 1472 Date 2026-01-05
- Courtesy of Jinwoo Yoon, Young Joo Suh / Severance Hospital
- Age/Sex 58 / F
- Chief ComplaintFever
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Granulomatosis with polyangiitis (GPA)
- Radiologic Findings
- Fig 1. Chest radiograph demonstrates subpleural nodules in right apex and increased opacities in both lower lung fields.
Fig 2-5. Chest CT scan reveals diffuse bronchial wall thickening bilaterally, multiple small nodules with peripheral distribution, and clustered centrilobular opacities in the right lung. - Brief Review
- Follow-up chest CT obtained one month later demonstrates progression with diffuse soft tissue thickening along the bronchovascular bundle and airway narrowing. Enlargement of multiple nodules is also noted.
The patient presented with fever and symptoms of paranasal sinusitis. Paranasal sinus (PNS) CT (not shown) revealed bilateral nasal polyps and maxillary and ethmoid sinusitis. Video-assisted thoracoscopic surgery (VATS) lung biopsy was performed to exclude infection and malignancy, revealing granulomatous inflammation with multinucleated giant cells and necrotizing vasculitis. Notably, the patients serum cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) testing was negative, while perinuclear ANCA (p-ANCA) was positive.
Granulomatosis with polyangiitis (GPA) is a small - References
- Keywords
No. of Applicants : 94
- ▶ Correct Answer : 20/94, 21.3%
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- - Funabashi General Hospital , Japan MANABU AKIMOTO
- - medical scanning , Japan HIROAKI ARAKAWA
- - , Japan HIROKI SAKURADA
- - Shiga University of Medical Science , Japan AKITOSHI INOUE
- - Kyoto University , Japan AKIHIKO SAKATA
- - Oita University, Faculty of Medicine , Japan FUMITO OKADA
- - , Japan HIROKI MIYAZAKI
- - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- - Nara Medical University , Japan AYA YAMADA
- - , Japan YOSHIKI ISHII
- - , Japan KEISUKE OSHIMA
- - Etlik City Hospital, Ankara , Turkey MERIC TUZUN
- - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- - Kantou Rousai Hospital , Japan KAORU SUMIDA
- - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
- - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
- - the first affiliatited hospital of nanjing medical univercity , China HAI XU
- - University of Yamanashi , Japan KOJIRO ONOHARA
- ▶ Correct Answer as Differential Diagnosis : 25/94, 26.6%
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- - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- - The University of Tokyo Hospital , Japan ISSEI FUKUDA
- - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
- - , Italy PAOLO BALDASSARI
- - Other , Korea (South) HEE SEOK CHOI
- - Other , Korea (South) SEONGSU KANG
- - Secomedic Hospital , Japan FUMINORI MIYOSHI
- - Seoul Medical Center , Korea (South) HATAEK JEONG
- - University of Yamanashi , Japan TAKAAKI HASHIMOTO
- - University of Yamanashi , Japan HIROAKI WATANABE
- - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- - Japanese Red Cross Otsu Hospital , Japan JUN YOSHIDA
- - , Japan KENTARO KOTANI
- - , Japan SHUNJIRO NOGUCHI
- - , Korea (South) HEONSEOK LEE
- - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- - , Japan MASAMICHI IWAI
- - GHICL , France MANUEL TOLEDANO
- - , Japan MATSUNO MAI
- - Kyoto University , Japan SHO KOYASU
- - University of Tsukuba Hospital , Japan SODAI HOSHIAI
- - Fukuoka university , Japan KEISUKE SATO
- - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- - Ehime University , Japan TOMOHISA OKADA
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